What are the clinical symptoms and physical signs for non‐small cell lung cancer before diagnosis is made? A nation‐wide multicenter 10‐year retrospective study in China

Abstract

Background Most lung cancer patients are diagnosed after the onset of symptoms. However, whether the symptoms of lung cancer were independently associated with the diagnosis of lung cancer is unknown, especially in the Chinese population. Methods We conducted a 10 years (2005‐2014) nationwide multicenter retrospective clinical epidemiology study of lung cancer patients diagnosed in China. As such, this study focused on nonsmall cell lung cancer (NSCLC). We calculated the odds ratios (ORs) for variables associated with the symptoms and physical signs using multivariate unconditional logistic regressions. Results A total of 7184 lung cancer patients were surveyed; finally, 6398 NSCLC patients with available information about their symptoms and physical signs were included in this analysis. The most common initial symptom and physical sign was chronic cough (4156, 65.0%), followed by sputum with blood (2110, 33.0%), chest pain (1146, 17.9%), shortness of breath (1090, 17.0%), neck and supraclavicular lymphadenectasis (629, 9.8%), weight loss (529, 8.3%), metastases pain (378, 5.9%), fatigue (307, 4.8%), fever (272, 4.3%), and dyspnea (270, 4.2%). Patients with squamous carcinoma and stage III disease were more likely to present with chronic cough ( P < 0.0001) and sputum with blood ( P < 0.0001) than patients with other pathological types and clinical stages, respectively. Metastases pain ( P < 0.0001) and neck and supraclavicular lymphadenectasis ( P = 0.0006) were more likely to occur in patients with nonsquamous carcinoma than in patients with other carcinomas. Additionally, patients with stage IV disease had a higher percentage of chest pain, shortness of breath, dyspnea, weight loss, and fatigue than patients with other stages of disease. In multivariable logistic analyses, compared with patients with adenocarcinoma, patients with squamous carcinoma were more likely to experience symptoms (OR = 2.885, 95% confidence interval [CI] 2.477‐3.359) but were less likely to present physical signs (OR = 0.844, 95% CI 0.721‐0.989). The odds of having both symptoms and physical signs were higher in patients with late‐stage disease than in those with early‐stage disease ( P < 0.0001). Conclusions The symptoms and physical signs of lung cancer were associated with the stage and pathological diagnosis of NSCLC. Patients with squamous carcinoma were more likely to develop symptoms, but not signs, than patients with adenocarcinoma. The more advanced the stage at diagnosis, the more likely that symptoms or physical signs are to develop. Further prospective cohort studies are needed to explore these results.

Mutational Profile Evaluates Response and Survival to First‐Line Chemotherapy in Lung Cancer

“…First, LADC was the dominant type in previous reports, followed by LUSC and SCLC. [ 16 ] However, the proportion of LUSC was higher than that of LADC in our study, indicating an alteration in histologic distribution within patients lacking a targetable oncogene driver. This discrepancy with previous reports could be due to the higher ratio of patients in LADC with targetable oncogene drivers.…”

“…In addition, 88.7% (165/186) of the patients were male, which was higher than that of some reports in China. [ 16 ] This may be due to the exclusion of EGFR or ALK ‐related driver gene mutations, as a considerable proportion of patients with TKI‐related driver gene mutations were nonsmoking patients. Therefore, the therapeutic response and long‐term prognosis of LUSC and male patients with no EGFR or ALK ‐related driver gene mutations are worth further investigation.…”

Lung cancer symptoms at diagnosis: results of a nationwide registry study

“…The frequency of haemoptysis, cough and chest pain was much higher across all stages than in our sample; however, dyspnoea was less frequent in the Chinese study. 6 With regard to the number of symptoms at diagnosis, a study published by Walter et al showed that 19% of lung cancer patients had two or more symptoms and 8.8% had three or more symptoms at diagnosis, 12 figures very similar to ours (21% and 12%, respectively). Unfortunately, this study did not break down the number of symptoms by tumour stage at diagnosis.…”

<p>A Systematic Review of Health Economic Evaluation on Targeted Therapies for First-Line Treatment of Metastatic Non-Small Cell Lung Cancer (NSCLC): Quality Evaluation</p>

“…Lung cancer is the most common form of cancer and the leading cause of cancerrelated mortality worldwide, resulting in about 1.7 million deaths each year. 1 Nonsmall-cell lung cancer (NSCLC) accounts for approximately 85-90% of all lung cancer cases, 2 inherently having a noticeable impact on health-care budgets. Among those cases, 10-20% of white patients and about 48% of Asian patients carry mutations in the epidermal growth factor receptor (EGFR) that play a key role in carcinogenesis.…”